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. 2016 May 17;50(10):4905-22.
doi: 10.1021/acs.est.5b06186. Epub 2016 Apr 25.

Untangling the Impacts of Climate Change on Waterborne Diseases: a Systematic Review of Relationships between Diarrheal Diseases and Temperature, Rainfall, Flooding, and Drought

Karen Levy  1 , Andrew P Woster  2 , Rebecca S Goldstein  1 , Elizabeth J Carlton  2
Affiliations

Untangling the Impacts of Climate Change on Waterborne Diseases: a Systematic Review of Relationships between Diarrheal Diseases and Temperature, Rainfall, Flooding, and Drought

Karen Levy et al. Environ Sci Technol. .

Abstract

Global climate change is expected to affect waterborne enteric diseases, yet to date there has been no comprehensive, systematic review of the epidemiological literature examining the relationship between meteorological conditions and diarrheal diseases. We searched PubMed, Embase, Web of Science, and the Cochrane Collection for studies describing the relationship between diarrheal diseases and four meteorological conditions that are expected to increase with climate change: ambient temperature, heavy rainfall, drought, and flooding. We synthesized key areas of agreement and evaluated the biological plausibility of these findings, drawing from a diverse, multidisciplinary evidence base. We identified 141 articles that met our inclusion criteria. Key areas of agreement include a positive association between ambient temperature and diarrheal diseases, with the exception of viral diarrhea and an increase in diarrheal disease following heavy rainfall and flooding events. Insufficient evidence was available to evaluate the effects of drought on diarrhea. There is evidence to support the biological plausibility of these associations, but publication bias is an ongoing concern. Future research evaluating whether interventions, such as improved water and sanitation access, modify risk would further our understanding of the potential impacts of climate change on diarrheal diseases and aid in the prioritization of adaptation measures.

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Figures

Figure 1
Figure 1
PRISMA diagram of the study selection process.
Figure 2
Figure 2
Comparison of the associations between diarrhea and exposures of interest presented in manuscripts with a single quantitative analysis to manuscripts with multiple analyses. Percentage of positive results shown for a) drought, flooding, heavy rainfall and temperature; and b) for subsets of temperature papers by type of pathogen reported on in the study. Number of analyses with reported significant positive associations over the total number of analyses is shown above each bar.
Figure 2
Figure 2
Comparison of the associations between diarrhea and exposures of interest presented in manuscripts with a single quantitative analysis to manuscripts with multiple analyses. Percentage of positive results shown for a) drought, flooding, heavy rainfall and temperature; and b) for subsets of temperature papers by type of pathogen reported on in the study. Number of analyses with reported significant positive associations over the total number of analyses is shown above each bar.
Figure 3
Figure 3
Map showing all studies included in the systematic review by country. The 8 studies that included 6 or more countries were excluded from the map. This includes 3 global studies, 2 European studies, 2 African studies and 1 South Asian study. World shapefile is from the GADM database of Global Administrative Area.
Figure 4
Figure 4
Conceptual diagram illustrating mechanisms by which meteorological conditions expected to be impacted by climate change could potentially increase the risk of diarrheal diseases. All arrows lead to increases in the items listed. Note that the diagram does not show possible mechanisms for how the same factors could potentially decrease the risk of diarrheal diseases.
Figure 5
Figure 5
Conceptual diagram for heavy rainfall and flooding illustrating how interventions along the causal pathway may interrupt transmission of diarrheal pathogens.
See this image and copyright information in PMC

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