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Literature review: Water quality and public health problems in developing countries

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Eni Muryani; Literature review: Water quality and public health problems in developing countries. AIP Conf. Proc. 23 November 2021; 2363 (1): 050020.

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Water’s essential function as drinking water is a significant daily intake. Contamination by microorganisms (bacteria or viruses) on water sources and drinking water supplies is a common cause in developing countries like Indonesia. This paper will discuss the sources of clean water and drinking water and their problems in developing countries; water quality and its relation to public health problems in these countries; and what efforts that can be make to improve water quality. The method used is a literature review from the latest journals. Water quality is influenced by natural processes and human activities around the water source Among developed countries, public health problems caused by low water quality, such as diarrhea, dysentery, cholera, typhus, skin itching, kidney disease, hypertension, heart disease, cancer, and other diseases the nervous system. Good water quality has a role to play in decreasing the number of disease sufferers or health issues due to drinking and the mortality rate. The efforts made to improve water quality and public health are by improving WASH (water, sanitation, and hygiene) facilities and infrastructure and also WASH education.

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Review article, effects of water pollution on human health and disease heterogeneity: a review.

  • 1 Research Center for Economy of Upper Reaches of the Yangtse River/School of Economics, Chongqing Technology and Business University, Chongqing, China
  • 2 School of Economics and Management, Huzhou University, Huzhou, China

Background: More than 80% of sewage generated by human activities is discharged into rivers and oceans without any treatment, which results in environmental pollution and more than 50 diseases. 80% of diseases and 50% of child deaths worldwide are related to poor water quality.

Methods: This paper selected 85 relevant papers finally based on the keywords of water pollution, water quality, health, cancer, and so on.

Results: The impact of water pollution on human health is significant, although there may be regional, age, gender, and other differences in degree. The most common disease caused by water pollution is diarrhea, which is mainly transmitted by enteroviruses in the aquatic environment.

Discussion: Governments should strengthen water intervention management and carry out intervention measures to improve water quality and reduce water pollution’s impact on human health.


Water is an essential resource for human survival. According to the 2021 World Water Development Report released by UNESCO, the global use of freshwater has increased six-fold in the past 100 years and has been growing by about 1% per year since the 1980s. With the increase of water consumption, water quality is facing severe challenges. Industrialization, agricultural production, and urban life have resulted in the degradation and pollution of the environment, adversely affecting the water bodies (rivers and oceans) necessary for life, ultimately affecting human health and sustainable social development ( Xu et al., 2022a ). Globally, an estimated 80% of industrial and municipal wastewater is discharged into the environment without any prior treatment, with adverse effects on human health and ecosystems. This proportion is higher in the least developed countries, where sanitation and wastewater treatment facilities are severely lacking.

Sources of Water Pollution

Water pollution are mainly concentrated in industrialization, agricultural activities, natural factors, and insufficient water supply and sewage treatment facilities. First, industry is the main cause of water pollution, these industries include distillery industry, tannery industry, pulp and paper industry, textile industry, food industry, iron and steel industry, nuclear industry and so on. Various toxic chemicals, organic and inorganic substances, toxic solvents and volatile organic chemicals may be released in industrial production. If these wastes are released into aquatic ecosystems without adequate treatment, they will cause water pollution ( Chowdhary et al., 2020 ). Arsenic, cadmium, and chromium are vital pollutants discharged in wastewater, and the industrial sector is a significant contributor to harmful pollutants ( Chen et al., 2019 ). With the acceleration of urbanization, wastewater from industrial production has gradually increased. ( Wu et al., 2020 ). In addition, water pollution caused by industrialization is also greatly affected by foreign direct investment. Industrial water pollution in less developed countries is positively correlated with foreign direct investment ( Jorgenson, 2009 ). Second, water pollution is closely related to agriculture. Pesticides, nitrogen fertilizers and organic farm wastes from agriculture are significant causes of water pollution (RCEP, 1979). Agricultural activities will contaminate the water with nitrates, phosphorus, pesticides, soil sediments, salts and pathogens ( Parris, 2011 ). Furthermore, agriculture has severely damaged all freshwater systems in their pristine state ( Moss, 2008 ). Untreated or partially treated wastewater is widely used for irrigation in water-scarce regions of developing countries, including China and India, and the presence of pollutants in sewage poses risks to the environment and health. Taking China as an example, the imbalance in the quantity and quality of surface water resources has led to the long-term use of wastewater irrigation in some areas in developing countries to meet the water demand of agricultural production, resulting in serious agricultural land and food pollution, pesticide residues and heavy metal pollution threatening food safety and Human Health ( Lu et al., 2015 ). Pesticides have an adverse impact on health through drinking water. Comparing pesticide use with health life Expectancy Longitudinal Survey data, it was found that a 10% increase in pesticide use resulted in a 1% increase in the medical disability index over 65 years of age ( Lai, 2017 ). The case of the Musi River in India shows a higher incidence of morbidity in wastewater-irrigated villages than normal-water households. Third, water pollution is related to natural factors. Taking Child Loess Plateau as an example, the concentration of trace elements in water quality is higher than the average world level, and trace elements come from natural weathering and manufacture causes. Poor river water quality is associated with high sodium and salinity hazards ( Xiao et al., 2019 ). The most typical water pollution in the middle part of the loess Plateau is hexavalent chromium pollution, which is caused by the natural environment and human activities. Loess and mudstone are the main sources, and groundwater with high concentrations of hexavalent chromium is also an important factor in surface water pollution (He et al., 2020). Finally, water supply and sewage treatment facilities are also important factors affecting drinking water quality, especially in developing countries. In parallel with China rapid economic growth, industrialization and urbanization, underinvestment in basic water supply and treatment facilities has led to water pollution, increased incidence of infectious and parasitic diseases, and increased exposure to industrial chemicals, heavy metals and algal toxins ( Wu et al., 1999 ). An econometric model predicts the impact of water purification equipment on water quality and therefore human health. When the proportion of household water treated with water purification equipment is reduced from 100% to 90%, the expected health benefits are reduced by up to 96%.. When the risk of pretreatment water quality is high, the decline is even more significant ( Brown and Clasen, 2012 ).

To sum up, water pollution results from both human and natural factors. Various human activities will directly affect water quality, including urbanization, population growth, industrial production, climate change, and other factors ( Halder and Islam, 2015 ) and religious activities ( Dwivedi et al., 2018 ). Improper disposal of solid waste, sand, and gravel is also one reason for decreasing water quality ( Ustaoğlua et al., 2020 ).

Impact of Water Pollution on Human Health

Unsafe water has severe implications for human health. According to UNESCO 2021 World Water Development Report , about 829,000 people die each year from diarrhea caused by unsafe drinking water, sanitation, and hand hygiene, including nearly 300,000 children under the age of five, representing 5.3 percent of all deaths in this age group. Data from Palestine suggest that people who drink municipal water directly are more likely to suffer from diseases such as diarrhea than those who use desalinated and household-filtered drinking water ( Yassin et al., 2006 ). In a comparative study of tap water, purified water, and bottled water, tap water was an essential source of gastrointestinal disease ( Payment et al., 1997 ). Lack of water and sanitation services also increases the incidence of diseases such as cholera, trachoma, schistosomiasis, and helminthiasis. Data from studies in developing countries show a clear relationship between cholera and contaminated water, and household water treatment and storage can reduce cholera ( Gundry et al., 2004 ). In addition to disease, unsafe drinking water, and poor environmental hygiene can lead to gastrointestinal illness, inhibiting nutrient absorption and malnutrition. These effects are especially pronounced for children.

Purpose of This Paper

More than two million people worldwide die each year from diarrhoeal diseases, with poor sanitation and unsafe drinking water being the leading cause of nearly 90% of deaths and affecting children the most (United Nations, 2016). More than 50 kinds of diseases are caused by poor drinking water quality, and 80% of diseases and 50% of child deaths are related to poor drinking water quality in the world. However, water pollution causes diarrhea, skin diseases, malnutrition, and even cancer and other diseases related to water pollution. Therefore, it is necessary to study the impact of water pollution on human health, especially disease heterogeneity, and clarify the importance of clean drinking water, which has important theoretical and practical significance for realizing sustainable development goals. Unfortunately, although many kinds of literature focus on water pollution and a particular disease, there is still a lack of research results that systematically analyze the impact of water pollution on human health and the heterogeneity of diseases. Based on the above background and discussion, this paper focuses on the effect of water pollution on human health and its disease heterogeneity.

Materials and Methods

Search process.

This article uses keywords such as “water,” “water pollution,” “water quality,” “health,” “diarrhea,” “skin disease,” “cancer” and “children” to search Web of Science and Google Scholar include SCI and SSCI indexed papers, research reports, and works from 1990 to 2021.

Inclusion-Exclusion Criteria and Data Extraction Process

The existing literature shows that water pollution and human health are important research topics in health economics, and scholars have conducted in-depth research. As of 30 December 2021, 104 related literatures were searched, including research papers, reviews and conference papers. Then, according to the content relevancy, 19 papers were eliminated, and 85 papers remained. The purpose of this review is to summarize the impact of water pollution on human health and its disease heterogeneity and to explore how to improve human health by improving water pollution control measures.

Information extracted from all included papers included: author, publication date, sample country, study methodology, study purpose, and key findings. All analysis results will be analyzed according to the process in Figure 1 .

FIGURE 1 . Data extraction process (PRISMA).

The relevant information of the paper is exported to the Excel database through Endnote, and the duplicates are deleted. The results were initially extracted by one researcher and then cross-checked by another researcher to ensure that all data had been filtered and reviewed. If two researchers have different opinions, the two researchers will review together until a final agreement is reached.

Quality Assessment of the Literature

The JBI Critical Appraisal Checklist was used to evaluate the quality of each paper. The JBI (Joanna Briggs Institute) key assessment tool was developed by the JBI Scientific Committee after extensive peer review and is designed for system review. All features of the study that meet the following eight criteria are included in the final summary:1) clear purpose; 2) Complete information of sample variables; 3) Data basis; 4) the validity of data sorting; 5) ethical norms; (6); 7) Effective results; 8) Apply appropriate quantitative methods and state the results clearly. Method quality is evaluated by the Yes/No questions listed in the JBI Key Assessment List. Each analysis paper received 6 out of 8.

The quality of drinking water is an essential factor affecting human health. Poor drinking water quality has led to the occurrence of water-borne diseases. According to the World Health Organization (WHO) survey, 80% of the world’s diseases and 50% of the world’s child deaths are related to poor drinking water quality, and there are more than 50 diseases caused by poor drinking water quality. The quality of drinking water in developing countries is worrying. The negative health effects of water pollution remain the leading cause of morbidity and mortality in developing countries. Different from the existing literature review, this paper mainly studies the impact of water pollution on human health according to the heterogeneity of diseases. We focuses on diarrhea, skin diseases, cancer, child health, etc., and sorts out the main effects of water pollution on human health ( Table 1 ).

TABLE 1 . Major studies on the relationship between water pollution and health.

Water Pollution and Diarrhea

Diarrhea is a common symptom of gastrointestinal diseases and the most common disease caused by water pollution. Diarrhea is a leading cause of illness and death in young children in low-income countries. Diarrhoeal diseases account for 21% of annual deaths among children under 5 years of age in developing countries ( Waddington et al., 2009 ). Many infectious agents associated with diarrhea are directly related to contaminated water ( Ahmed and Ismail, 2018 ). Parasitic worms present in non-purifying drinking water when is consumed by human beings causes diseases ( Ansari and Akhmatov., 2020 ) . It was found that treated water from water treatment facilities was associated with a lower risk of diarrhea than untreated water for all ages ( Clasen et al., 2015 ). For example, in the southern region of Brazil, a study found that factors significantly associated with an increased risk of mortality from diarrhoea included lack of plumbed water, lack of flush toilets, poor housing conditions, and overcrowded households. Households without access to piped water had a 4.8 times higher risk of infant death from diarrhea than households with access to piped water ( Victora et al., 1988 )

Enteroviruses exist in the aquatic environment. More than 100 pathogenic viruses are excreted in human and animal excreta and spread in the environment through groundwater, estuarine water, seawater, rivers, sewage treatment plants, insufficiently treated water, drinking water, and private wells ( Fong and Lipp., 2005 ). A study in Pakistan showed that coliform contamination was found in some water sources. Improper disposal of sewage and solid waste, excessive use of pesticides and fertilizers, and deteriorating pipeline networks are the main causes of drinking water pollution. The main source of water-borne diseases such as gastroenteritis, dysentery, diarrhea, and viral hepatitis in this area is the water pollution of coliform bacteria ( Khan et al., 2013 ). Therefore, the most important role of water and sanitation health interventions is to hinder the transmission of diarrheal pathogens from the environment to humans ( Waddington et al., 2009 ).

Meta-analyses are the most commonly used method for water quality and diarrhea studies. It was found that improving water supply and sanitation reduced the overall incidence of diarrhea by 26%. Among Malaysian infants, having clean water and sanitation was associated with an 82% reduction in infant mortality, especially among infants who were not breastfed ( Esrey et al., 1991 ). All water quality and sanitation interventions significantly reduced the risk of diarrhoeal disease, and water quality interventions were found to be more effective than previously thought. Multiple interventions (including water, sanitation, and sanitation measures) were not more effective than single-focus interventions ( Fewtrell and Colford., 2005 ). Water quality interventions reduced the risk of diarrhoea in children and reduced the risk of E. coli contamination of stored water ( Arnold and Colford., 2007 ). Interventions to improve water quality are generally effective in preventing diarrhoea in children of all ages and under 5. However, some trials showed significant heterogeneity, which may be due to the research methods and their conditions ( Clasen et al., 2007 ).

Water Pollution and Skin Diseases

Contrary to common sense that swimming is good for health, studies as early as the 1950s found that the overall disease incidence in the swimming group was significantly higher than that in the non-swimming group. The survey shows that the incidence of the disease in people under the age of 10 is about 100% higher than that of people over 10 years old. Skin diseases account for a certain proportion ( Stevenson, 1953 ). A prospective epidemiological study of beach water pollution was conducted in Hong Kong in the summer of 1986–1987. The study found that swimmers on Hong Kong’s coastal beaches were more likely than non-swimmers to complain of systemic ailments such as skin and eyes. And swimming in more polluted beach waters has a much higher risk of contracting skin diseases and other diseases. Swimming-related disease symptom rates correlated with beach cleanliness ( Cheung et al., 1990 ).

A study of arsenic-affected villages in the southern Sindh province of Pakistan emphasized that skin diseases were caused by excessive water quality. By studying the relationship between excessive arsenic in drinking water caused by water pollution and skin diseases (mainly melanosis and keratosis), it was found that compared with people who consumed urban low-arsenic drinking water, the hair of people who consumed high-arsenic drinking water arsenic concentration increased significantly. The level of arsenic in drinking water directly affects the health of local residents, and skin disease is the most common clinical complication of arsenic poisoning. There is a correlation between arsenic concentrations in biological samples (hair and blood) from patients with skin diseases and intake of arsenic-contaminated drinking water ( Kazi et al., 2009 ). Another Bangladesh study showed that many people suffer from scabies due to river pollution ( Hanif et al., 2020 ). Not only that, but water pollution from industry can also cause skin cancer ( Arif et al., 2020 ).

Studies using meta-analysis have shown that exposure to polluted Marine recreational waters can have adverse consequences, including frequent skin discomfort (such as rash or itching). Skin diseases in swimmers may be caused by a variety of pathogenic microorganisms ( Yau et al., 2009 ). People (swimmers and non-swimmers) exposed to waters above threshold levels of bacteria had a higher relative risk of developing skin disease, and levels of bacteria in seawater were highly correlated with skin symptoms.

Studies have also suggested that swimmers are 3.5 times more likely to report skin diseases than non-swimmers. This difference may be a “risk perception bias” at work on swimmers, who are generally aware that such exposure may lead to health effects and are more likely to detect and report skin disorders. It is also possible that swimmers exaggerated their symptoms, reporting conditions that others would not classify as true skin disorders ( Fleisher and Kay. 2006 ).

Water Pollution and Cancer

According to WHO statistics, the number of cancer patients diagnosed in 2020 reached 19.3 million, while the number of deaths from cancer increased to 10 million. Currently, one-fifth of all global fevers will develop cancer during their lifetime. The types and amounts of carcinogens present in drinking water will vary depending on where they enter: contamination of the water source, water treatment processes, or when the water is delivered to users ( Morris, 1995 ).

From the perspective of water sources, arsenic, nitrate, chromium, etc. are highly associated with cancer. Ingestion of arsenic from drinking water can cause skin cancer and kidney and bladder cancer ( Marmot et al., 2007 ). The risk of cancer in the population from arsenic in the United States water supply may be comparable to the risk from tobacco smoke and radon in the home environment. However, individual susceptibility to the carcinogenic effects of arsenic varies ( Smith et al., 1992 ). A high association of arsenic in drinking water with lung cancer was demonstrated in a northern Chilean controlled study involving patients diagnosed with lung cancer and a frequency-matched hospital between 1994 and 1996. Studies have also shown a synergistic effect of smoking and arsenic intake in drinking water in causing lung cancer ( Ferreccio et al., 2000 ). Exposure to high arsenic levels in drinking water was also associated with the development of liver cancer, but this effect was not significant at exposure levels below 0.64 mg/L ( Lin et al., 2013 ).

Nitrates are a broader contaminant that is more closely associated with human cancers, especially colorectal cancer. A study in East Azerbaijan confirmed a significant association between colorectal cancer and nitrate in men, but not in women (Maleki et al., 2021). The carcinogenic risk of nitrates is concentration-dependent. The risk increases significantly when drinking water levels exceed 3.87 mg/L, well below the current drinking water standard of 50 mg/L. Drinking water with nitrate concentrations lower than current drinking water standards also increases the risk of colorectal cancer ( Schullehner et al., 2018 ).

Drinking water with high chromium content will bring high carcinogenicity caused by hexavalent chromium to residents. Drinking water intake of hexavalent chromium experiments showed that hexavalent chromium has the potential to cause human respiratory cancer. ( Zhitkovich, 2011 ). A case from Changhua County, Taiwan also showed that high levels of chromium pollution were associated with gastric cancer incidence ( Tseng et al., 2018 ).

There is a correlation between trihalomethane (THM) levels in drinking water and cancer mortality. Bladder and brain cancers in both men and women and non-Hodgkin’s lymphoma and kidney cancer in men were positively correlated with THM levels, and bladder cancer mortality had the strongest and most consistent association with THM exposure index ( Cantor et al., 1978 ).

From the perspective of water treatment process, carcinogens may be introduced during chlorine treatment, and drinking water is associated with all cancers, urinary cancers and gastrointestinal cancers ( Page et al., 1976 ). Chlorinated byproducts from the use of chlorine in water treatment are associated with an increased risk of bladder and rectal cancer, with perhaps 5,000 cases of bladder and 8,000 cases of rectal cancer occurring each year in the United States (Morris, 1995).

The impact of drinking water pollutants on cancer is complex. Epidemiological studies have shown that drinking water contaminants, such as chlorinated by-products, nitrates, arsenic, and radionuclides, are associated with cancer in humans ( Cantor, 1997 ). Pb, U, F- and no3- are the main groundwater pollutants and one of the potential causes of cancer ( Kaur et al., 2021 ). In addition, many other water pollutants are also considered carcinogenic, including herbicides and pesticides, and fertilizers that contain and release nitrates ( Marmot et al., 2007 ). A case from Hebei, China showed that the contamination of nitrogen compounds in well water was closely related to the use of nitrogen fertilizers in agriculture, and the levels of three nitrogen compounds in well water were significantly positively correlated with esophageal cancer mortality ( Zhang et al., 2003 ).

In addition, due to the time-lag effect, the impact of watershed water pollution on cancer is spatially heterogeneous. The mortality rate of esophageal cancer caused by water pollution is significantly higher downstream than in other regions due to the impact of historical water pollution ( Xu et al., 2019 ). A study based on changes in water quality in the watershed showed that a grade 6 deterioration in water quality resulted in a 9.3% increase in deaths from digestive cancer. ( Ebenstein, 2012 ).

Water Pollution and Child Health

Diarrhea is a common disease in children. Diarrhoeal diseases (including cholera) kill 1.8 million people each year, 90 per cent of them children under the age of five, mostly in developing countries. 88% of diarrhoeal diseases are caused by inadequate water supply, sanitation and hygiene (Team, 2004). A large proportion of these are caused by exposure to microbially infected water and food, and diarrhea in infants and young children can lead to malnutrition and reduced immune resistance, thereby increasing the likelihood of prolonged and recurrent diarrhea ( Marino, 2007 ). Pollution exposure experienced by children during critical periods of development is associated with height loss in adulthood ( Zaveri et al., 2020 ). Diseases directly related to water and sanitation, combined with malnutrition, also lead to other causes of death, such as measles and pneumonia. Child malnutrition and stunting due to inadequate water and sanitation will continue to affect more than one-third of children in the world ( Bartlett, 2003 ). A study from rural India showed that children living in households with tap water had significantly lower disease prevalence and duration ( Jalan and Ravallion, 2003 ).

In conclusion, water pollution is a significant cause of childhood diseases. Air, water, and soil pollution together killed 940,000 children worldwide in 2016, two-thirds of whom were under the age of 5, and the vast majority occurred in low- and middle-income countries ( Landrigan et al., 2018 ). The intensity of industrial organic water pollution is positively correlated with infant mortality and child mortality in less developed countries, and industrial water pollution is an important cause of infant and child mortality in less developed countries ( Jorgenson, 2009 ). In addition, arsenic in drinking water is a potential carcinogenic risk in children (García-Rico et al., 2018). Nitrate contamination in drinking water may cause goiter in children ( Vladeva et al.., 2000 ).


This paper reviews the environmental science, health, and medical literature, with a particular focus on epidemiological studies linking water quality, water pollution, and human disease, as well as studies on water-related disease morbidity and mortality. At the same time, special attention is paid to publications from the United Nations and the World Health Organization on water and sanitation health research. The purpose of this paper is to clarify the relationship between water pollution and human health, including: The relationship between water pollution and diarrhea, the mechanism of action, and the research situation of meta-analysis; The relationship between water pollution and skin diseases, pathogenic factors, and meta-analysis research; The relationship between water pollution and cancer, carcinogenic factors, and types of cancer; The relationship between water pollution and Child health, and the major childhood diseases caused.

A study of more than 100 literatures found that although factors such as country, region, age, and gender may have different influences, in general, water pollution has a huge impact on human health. Water pollution is the cause of many human diseases, mainly diarrhoea, skin diseases, cancer and various childhood diseases. The impact of water pollution on different diseases is mainly reflected in the following aspects. Firstly, diarrhea is the most easily caused disease by water pollution, mainly transmitted by enterovirus existing in the aquatic environment. The transmission environment of enterovirus depends on includes groundwater, river, seawater, sewage, drinking water, etc. Therefore, it is necessary to prevent the transmission of enterovirus from the environment to people through drinking water intervention. Secondly, exposure to or use of heavily polluted water is associated with a risk of skin diseases. Excessive bacteria in seawater and heavy metals in drinking water are the main pathogenic factors of skin diseases. Thirdly, water pollution can pose health risks to humans through any of the three links: the source of water, the treatment of water, and the delivery of water. Arsenic, nitrate, chromium, and trihalomethane are major carcinogens in water sources. Carcinogens may be introduced during chlorine treatment from water treatment. The effects of drinking water pollution on cancer are complex, including chlorinated by-products, heavy metals, radionuclides, herbicides and pesticides left in water, etc., Finally, water pollution is an important cause of children’s diseases. Contact with microbiologically infected water can cause diarrhoeal disease in children. Malnutrition and weakened immunity from diarrhoeal diseases can lead to other diseases.

This study systematically analyzed the impact of water pollution on human health and the heterogeneity of diseases from the perspective of different diseases, focusing on a detailed review of the relationship, mechanism and influencing factors of water pollution and diseases. From the point of view of limitations, this paper mainly focuses on the research of environmental science and environmental management, and the research on pathology is less involved. Based on this, future research can strengthen research at medical and pathological levels.

In response to the above research conclusions, countries, especially developing countries, need to adopt corresponding water management policies to reduce the harm caused by water pollution to human health. Firstly, there is a focus on water quality at the point of use, with interventions to improve water quality, including chlorination and safe storage ( Gundry et al., 2004 ), and provision of treated and clean water ( Khan et al., 2013 ). Secondly, in order to reduce the impact of water pollution on skin diseases, countries should conduct epidemiological studies on their own in order to formulate health-friendly bathing water quality standards suitable for their specific conditions ( Cheung et al., 1990 ). Thirdly, in order to reduce the cancer caused by water pollution, the whole-process supervision of water quality should be strengthened, that is, the purity of water sources, the scientific nature of water treatment and the effectiveness of drinking water monitoring. Fourthly, each society should prevent and control source pollution from production, consumption, and transportation ( Landrigan et al., 2018 ). Fifthly, health education is widely carried out. Introduce environmental education, educate residents on sanitary water through newspapers, magazines, television, Internet and other media, and enhance public health awareness. Train farmers to avoid overuse of agricultural chemicals that contaminate drinking water.

Author Contributions

Conceptualization, XX|; methodology, LL; data curation, HY; writing and editing, LL; project administration, XX|.

This article is a phased achievement of The National Social Science Fund of China: Research on the blocking mechanism of the critical poor households returning to poverty due to illness, No: 20BJY057.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords: water pollution, human health, disease heterogeneity, water intervention, health cost

Citation: Lin L, Yang H and Xu X (2022) Effects of Water Pollution on Human Health and Disease Heterogeneity: A Review. Front. Environ. Sci. 10:880246. doi: 10.3389/fenvs.2022.880246

Received: 21 February 2022; Accepted: 09 June 2022; Published: 30 June 2022.

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Copyright © 2022 Lin, Yang and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Xiaocang Xu, [email protected]

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Bioaerosol Emission Characteristics and the Epidemiological, Occupational, and Public Health Risk Assessment of Waste and Wastewater Management

A review of water pollution arising from agriculture and mining activities in Central Asia: Facts, causes and effects


  • 1 School of Environmental Science and Engineering, Guangzhou University, Guangzhou, 510006, China; Linkoping University-Guangzhou University Research Center on Urban Sustainable Development, Guangzhou University, Guangzhou, 510006, China.
  • 2 Key Laboratory of Water Cycle and Related Land Surface Processes, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100049, China. Electronic address: [email protected].
  • 3 Scientific Information Center of Interstate Coordination Water Commission of Central Asia, Tashkent, 100187, Uzbekistan.
  • 4 Key Laboratory of Water Cycle and Related Land Surface Processes, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100049, China.
  • 5 School of Environmental Science and Engineering, Guangzhou University, Guangzhou, 510006, China.
  • PMID: 34563852
  • DOI: 10.1016/j.envpol.2021.118209

Central Asia is one of many regions worldwide that face severe water shortages; nevertheless, water pollution in this region exacerbates the existing water stress and increases the risk of regional water conflicts. In this study, we perform an extensive literature review, and the data show that water pollution in Central Asia is closely linked to human activities. Within the Asian Gold Belt, water pollution is influenced mainly by mining, and the predominant pollutants are heavy metals and radionuclides. However, in the irrigated areas along the middle and lower reaches of inland rivers (e.g., the Amu Darya and Syr Darya), water pollution is strongly associated with agriculture. Hence, irrigated areas are characterized by high concentrations of ammonia, nitrogen, and phosphorus. In addition, the salinities of rivers and groundwater in the middle and lower reaches of inland rivers generally increase along the flow path due to high rates of evaporation. Soil salinization and frequent salt dust storms in the Aral Sea basin further increase the pollution of surface water bodies. Ultimately, the pollution of surface water and groundwater poses risks to human health and deteriorates the ecological environment. To prevent further water pollution, joint monitoring of the surface water and groundwater quantity and quality throughout Central Asia must be implemented immediately.

Keywords: Agriculture; Central Asia; Mining activities; Water pollution.

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Water Pollution: A Review

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literature review in water pollution

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Water is a very important element for living organisms, and it is helpful in the circulation and transmission of nutrients in the biosphere. Due to industrialization, urbanization, and rapid increase in human population, the demand for water has increased sharply, and the quality has declined drastically. Although water has the ability to purify itself, when the concentration of pollutants generated from man-made sources becomes so high that it exceeds the self-purifying ability of water, then the water becomes polluted. Degradation of the physical, chemical, and biological characteristics of water by natural and man-made processes in such a way that it is unsuitable for humans and other biological communities. This is called water pollution.

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Dadsena, N., Nair, S.J. (2024). Water Pollution: A Review. In: Deka, J.K., Robi, P.S., Sharma, B. (eds) Emerging Technology for Sustainable Development. EGTET 2022. Lecture Notes in Electrical Engineering, vol 1061. Springer, Singapore.

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The global progress on the non-point source pollution research from 2012 to 2021: a bibliometric analysis

  • Zi-jian Xie 1 ,
  • Chun Ye   ORCID: 1 ,
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With effective control of point source pollution, non-point source (NPS) pollution has been widely concerned as the primary reason for the improvement of global water environmental quality. Some bibliometric analysis related to NPS pollution has been carried out before the mid-2010s. Analyzing the research status and hot issues of NPS pollution in the past decade is important for guiding the control and management of NPS pollution in the future.

A bibliometric analysis was conducted based on 3407 publications retrieved from the Web of Science during 2012–2021. China, USA and UK were the most productive countries. Sci. Total Environ, Environ. Sci. Pollut. Res, and Water were the most productive journals. The NPS pollutant, pollution types, driving forces, technology and the research object were retrieved from the keywords analysis. The common NPS pollutants of nitrogen, phosphorus, and heavy metals grabbed the highest attention, while the emerging contaminants have attracted increased attention. The migration and transformation of agricultural NPS pollution and urban NPS pollution driven by climate change and land use change were hot issues related to NPS pollution studies. Technologies related to the combination of 3S technology (RS, GIS, and GPS) and NPS pollution models, the sustainable control technologies, the technology of accurate traceability and automatic monitoring, and the comprehensive management plan were the important research areas related to NPS pollution. Although the research locations were mostly concentrated in the surface water and groundwater, the ocean and drinking water have great potential for future research.


This study illustrates the global focuses related to NPS pollution during 2012–2021 according to analyzing the publication outputs, source journals, source country, author, institution and the high-frequency keywords. Results demonstrated that the migration and transformation mechanism and ecological risk assessment for heavy metals and emerging pollutants, accurate traceability techniques, sustainable ecological restoration control techniques, and marine pollution have attracted rising attention. Additionally, developing countries will have a higher interest in NPS pollution in the future, because developed countries have already made great progress in controlling NPS pollution.

Historically, most research has focused on point source (PS) pollution because it was considered as one of the main causes contributing to the water pollution problem [ 80 , 59 ]. With the effectively control on the PS pollution in recent years, the NPS pollution was reported as one of the most important sources threatening the security of water resources, and even contributed to the outbreak of water blooms [ 43 , 80 ]. Compared with PS pollution, non-point source (NPS) pollution has some distinguished characteristics of dispersive sources, diversified types, great randomness and abruptness [ 42 , 59 ].

The progress in NPS pollution control differs considerably from country to country. At the end of the twentieth century, some developed countries found that the NPS pollution transformed to the primary pollution source in many waters (US [ 39 , 40 , 72 ]. For example, USA has accounted that 60% of water pollution originated from NPS pollution (US [ 72 ],94% of the nitrogen load and 52% of the phosphorus load in 270 Denmark rivers were caused by NPS pollution [ 39 , 40 ]. Then, developed countries have made great effort against NPS pollution. The implementation of the Clean Water Act (CWA) of USA, Watershed Protection Approach (WPA) of USA, EU Drinking Water Directive (DWD), and EU Water Framework Directive (WFD) have pointed out specific measures for controlling NPS pollution. Developing countries pay less attention to NPS pollution than developed countries due to the limited pollution control techniques and funds. Among all developing countries, China paid the highest attention to NPS pollution [ 42 , 83 ]. The research on NPS pollution in China sprouted in the mid-1980s, which was approximately 20 years behind the USA and EU [ 42 , 83 ]. Although Chinese government has issued many laws on NPS pollution, such as the Environmental Protection Law (EPL), Water Pollution Control Law (WPCL), and Yangtze River Protection Law (YRPL), NPS pollution is still the bottleneck restricting the improvement of water quality in China [ 65 , 68 ]. In terms of the first and second longest rivers in China, almost 50% of nitrogen and phosphorus pollution in the Yangtze River basin resulted from the agricultural NPS (Zhang F, 2020), and more than 60% of total phosphorus emissions in the nine provinces of the Yellow River basin was caused by the NPS pollution [ 69 ]. Therefore, analyzing the research status and hot issues of NPS pollution is of great guidance for the NPS pollution controlling around the world, especially for developing countries.

Bibliometrics is an interdisciplinary science which utilizes mathematical and statistical methods to quantitatively evaluate the research output of various disciplines and fields [ 42 , 55 ]. Bibliometrics analysis is beneficial to summarize the research status and hot topics of the searched field. Additionally, it is of great significance to grasp the latest progress and innovative issues, and enhance the efficiency of scientific research [ 55 , 83 ]. Although bibliometric analysis has been carried out on NPS pollution in river basins, most research were completed before the mid-2010s [ 42 , 74 , 83 ].

This study aimed to analyze the global trend and hot issues of NPS pollution in the past decade from the bibliometrics perspective. The research not only analyzes the document type, language, annual publication outputs, source journals, source country, author and institution, but also illustrates the high-frequency keywords and the co-occurrence of keywords. The results are beneficial to comprehend the hot issues of NPS pollution, and providing important guidance for future research.

Materials and methods

Data collection.

Due to the popular use of Web of Science (WoS) [Science Citation Index Expanded (SCI-EXPANDED) and Social Sciences Citation Index (SSCI)] in the academic world, WoS was selected as the key database for this research. ‘Non-point source pollution’, ‘diffuse pollution’ were chosen as the keywords to search publications published during 2012–2021. The keyword retrieval object was title, abstract, author keywords and keywords plus. The date of retrieval of the database was January 2nd, 2022.

Totally, 3576 publications were found, including research articles (95.48%), review papers (3.77%), proceeding papers (2.10%), and other publications. In terms of publication language, English is the most frequently used (98.76%), followed by Portuguese (0.40%), Spanish (0.23%), etc. Only 3407 English publications of journal articles and reviews were used for further analysis.

Data analysis

This paper makes a bibliometric analysis of the literature related to NPS pollution in the past decade according to the publication year, regional distribution, author, institution and keywords. The processing software includes Microsoft office 2013, Bibexcel v2016.02.20, Vosviewer and Scimago Graphica. Microsoft office 2013 used to analyze the annual publications and total citations, the top 20 productive authors and source journals. Bibexcel v2016.02.20 used to consolidate and extract the plain data downloaded from the WoS. Vosviewer and Scimago Graphica used to draw the collaboration network of institutions and the co-occurrence map of keywords.

Results and discussion

Performance of publication output.

A total of 3407 articles related to NPS pollution were published in the SCI-EXPANDED and SSCI between 2012 and 2021. As shown in Fig.  1 , the publications related to NPS pollution increased from 257 in 2012 to 519 in 2021, and the annual publication was 341. Compared with the period of 1992–2001 (49 articles per year) and 2002–2011 (165 articles per year), the related articles increased obviously during 2012–2021, indicating that NPS pollution has attracted expanding attention around the world. The annual citations of articles from 2012 to 2019 were higher than 5000 times, and the total citations from 2020 to 2021 were relatively lower (Fig.  1 ), which was connected to the short publication time of articles.

figure 1

The publications and total citations on NPS pollution research from 2012–2021

Performance of countries/territories

During 2012 to 2021, a total of 110 countries/territories participated in the study of NPS pollution, and 54 countries/territories published more than 10 articles. This demonstrates that nearly half of the countries/territories did not conduct in-depth study on NPS pollution with only a few publications. As shown in Fig.  2 , China, USA, and UK were the most productive countries, with 1287, 560 and 358 articles, respectively. In terms of the international collaborative research, China and the USA had the highest cooperation intensity. Meanwhile, as the country with the largest number of publications in the past decade, China, USA and EU maintains the closet cooperation (Fig.  2 ).

figure 2

The geographical distribution and cooperation network of the top 29 productive countries/territories during 2012–2021

The research on NPS pollution in the USA, UK and other developed countries was 20 years earlier than that in China, the USA and UK was the most productive country, and had the strongest cooperative network in the global collaboration before the 2010s [ 42 , 83 ]. China accounts for approximately 20% of the world’s population and 7% of the world’s arable land. Over 50% of the nitrogen and phosphorus pollution in the Yangtze River basin and phosphorus pollution in the Yellow River basin caused by the NPS pollution (Zhang F, 2020,[ 69 ]. Compared with developed countries, China has suffered more from NPS pollution over the last decade. Inversely, developed countries have achieved considerable achievements in controlling NPS pollution due to the implementation of numerous effective programs.

In the USA, the major programs related to NPS pollution include the Great Lakes Restoration Initiative (GLRI), Clean Water State Revolving Fund (CWSRF), and National Water Quality Program (NWQP), etc. As the largest investment in the Great Lakes over the latest 20 years, the GLRI has focused on the excessive nutrient loading, agricultural and stormwater runoff, industrial pollution, wildlife waste, that could degrade region water quality (Tyner et al., 2020; [ 29 ]. The CWSRF effectively supported the implementation of the CWA, it has provided low-cost financial assistance for stormwater mitigation, non-point source pollution control, estuary management project, etc. [ 6 , 15 ]. The NWQP has provided research, education, and extension activities on eight key “themes” identifying agricultural and rural NPS pollution, and effectively improved the quality of water resources throughout the USA and its territories, particularly in agriculturally managed watersheds.

Similarly, EU has also funded many projects related to NPS pollution, such as SOLUTIONS, MODELKEY, WISER, etc. SOLUTIONS is a large integrated project, funded by the European Commission under the WFD. This project has proposed new and improved tools, models, and methods to support decisions in environmental and water policies, particularly for present and future emerging pollutants in the River Danube and River Rhine [ 14 , 56 ]. MODELKEY is dedicated to the use of models to assess and predict the effect of environmental key pollutants on marine and freshwater ecosystems and biodiversity, the research was mainly focused on the River Elbe, River Schelde, and River Llobregat [ 30 ]. Similarly, WISER has developed methods for assessing and restoring aquatic ecosystems, and addressed the assessment and management of rivers, lakes, transitional and coastal waters in EU [ 11 , 12 ].

In China, the major projects related to NPS pollution include the Major Science and Technology Program for Water Pollution Control and Treatment (Water Major Project), the National Water Pollution Prevention and Control Reserve Project, the Key Project for the Comprehensive Treatment of Major Rivers, such as the Yangtze and Yellow rivers, for Water Resources and Environment, etc. The Water Major Project was the largest investment in water pollution control technology project in China. This project has developed a number of technologies for China’s key scientific issues in water pollution treatment and management, and effectively improved the water quality in some typical demonstration water shed. The National Water Pollution Prevention and Control Reserve Project effectively supported the implementation of the Action Plan for Prevention and Control of Water Pollution by identifying the major pollution problems in the surface water, groundwater and drinking water of key river basins in China, and effectively improved the ecological environment quality of target river basins through the implementation of engineering measures. Additionally, the Key Project for the Comprehensive Treatment of Major Rivers, such as the Yangtze and Yellow rivers, for Water Resources and Environment, aims to solve scientific and technical bottlenecks in the integrated management of water resources, water environment and water ecology in China’s key river basins.

Performance of authors and institutions

A total of 11773 authors retrieved during 2012–2021 from the processing 3407 articles. Nearly 11430 authors (97%) published less than 3 articles, while 58 people published articles were higher than 10, with a total of 1033 articles. As shown in Fig.  3 , Wei Ouyang from Beijing Normal University took the highest number of articles (55) and H-index (19). His main research interest is the simulation and control of NPS pollution in watersheds [ 54 ]. The top 20 most productive authors were mainly come from China, USA and UK (Fig.  3 ). The previous analysis showed that Raghavan Srinivasan from the United States Department of Agricultural Research Service contributed the most articles and the North America and Europe accounted for 10 and 6 of the top 20 productive authors during 1991–2015 [ 42 ]. Although scientists from North America and Europe still have a high influence on long time series, Chinese researchers have gained increasing academic and personal influence in the last decade.

figure 3

The distribution of the top 20 authors with their H-index values during 2012–2021

Meanwhile, a total of 3313 institutions were retrieved from the WoS database between 2012 and 2021. 3120 institutions (94%) published less than 10 articles, while 193 institutions published articles were higher than 10 (6%). According to the analysis of top 21 productive institutions (≥ 25 articles) and their cooperation intensity, Chinese Academy of Sciences published the highest number of articles (304), and has close links with other institutions, followed by Beijing Normal University (162) (Fig.  4 ). Among these 21 institutions 15 come from China (71%) and 6 come from the UK (29%). In the past decade, these research institutions have actively conducted research on NPS pollution, which indicates that they have strong scientific research strength and competitiveness.

figure 4

The publications and cooperation network of the top 21 productive institutions from 2012–2021

Performance of publication sources and highly cited articles

The 3407 publications were collected from a wide range of 690 journals. Among these 690 journals, 631 journals (91%) published less than 10 articles related to NPS pollution, while 20 journals (3%) published more than 10 articles. Fig.  5 demonstrates the distribution of the top 20 most productive journals and their H-index during the past decade. Sci. Total Environ ranked the first and published 268 (7.9%) publications, which indicated that this journal paid more attention to NPS research; meanwhile, the second most productive journal was Environ. Sci. Pollut. Res (164 publication; 4.8%), followed by Water (127 publications; 3.7%) (Fig.  5 ). With regard to the H-index, Sci. Total Environ was also ranked first (45), while Agric. Ecosyst. Environ (25) and Water Res (24) ranked second and third, respectively (Fig.  5 ). In terms of the 3-year impact factors (IF), the highest three journals were Water Res (9.427) J. Clean Prod (7.646) Environ. Pollut (6.857).

figure 5

The publications and H-index for the top 20 productive source journals with NPS pollution research from 2012–2021

The top 20 cited articles retrieved in WoS database were total cited 5031 times, and the average citation was 252 times (Table 1 ). These articles were published in 14 journals. Six articles were published in Sci. Total Environ , and two published in Agric. ecosyst. Environ . The corresponding authors come from 14 countries. China and UK ranked first with three publications, followed by the USA (2) and France (2). These countries have the greatest influence on NPS pollution research. The most widely cited research was entitled “ Effectiveness of low impact development practices: Literature review and suggestions for future research ” in Water Air and Soil Pollution [ 2 ]. This article highlights evidence in the literature regarding the beneficial uses of low impact development (LID) practices, and suggests directions for future research opportunities.

Hot issues and development trend of NPS pollution based on the keywords analysis

Keywords analysis in scientific contributions are beneficial for identifying the hot issues and trends in a particular field [ 55 ]. Authors tend to list a number of keywords that are closely related to the article. A total of 14819 keywords appeared in all articles retrieved from WoS during 2012–2021. 1275 keywords occurred more than 5 times, and 568 keywords occurred more than 10 times.

Previously, bibliometrics mostly used 30–100 keywords to analyze the research hotspots and development trends [ 42 , 55 ], which was not conducive to a comprehensive understanding of the aimed topic. In this study, 568 keywords occurred more than 10 times were taken as the target database, then reclassified it from the aspects of NPS pollutants, pollution types, driving factors, the key points of NPS pollution technology research and the research object.

The NPS pollutants were diversified

Regarding the 568 keywords with the occurrence frequency more than 10, a total of 75 keywords related to NPS pollutants, which could be divided into seven categories, including nitrogen, phosphorus, heavy metals, carbon, emerging contaminants, pesticides, and microorganisms (Fig.  6 ).

figure 6

The co-occurrence map of keywords on the research of NPS pollutants from 2012–2021

Nitrogen and phosphorus were the main pollutants causing water eutrophication. The frequency of nitrogen and phosphorus ranked first (803 times) and second (530 times), accounting for 33.05% and 21.81%, respectively. The high-frequency keywords related to nitrogen include ‘nitrate pollution’, ‘nitrogen loss’, ‘nitrogen removal’, ‘source nitrogen’, ‘ammonia volatilization’, ‘nitrogen use efficiency’, ‘nitrogen deposition’, etc. The high-frequency keywords related to phosphorus constitute ‘phosphorus retention’, ‘phosphorus loss’, ‘phosphorus loads’, etc. The research on the migration and transformation paths of nitrogen and phosphorus and their influence on the quantification of water quality is a challenge in many watershed studies [ 55 , 83 ].

Heavy-metals pollution which is caused by mining, industrial production, agricultural activities and urbanization severely endangers human health and safety [ 16 , 17 ]. The frequency of heavy metals was ranked third (477 times), accounting for 19.63%. The high-frequency keywords related to heavy metals include ‘cadmium’, ‘copper’, ‘plumbum’, ‘mercury’, ‘zinc’, ‘arsenic’, etc. The migration, transformation and distribution of heavy metals in sediments of the estuary and urban runoff is the current research focus [ 9 , 27 ].

Carbon is the major component of organic matter in soil and water. Dissolved organic matter is one of the main factors leading to the water eutrophication in lakes and reservoirs [ 23 , 38 ]. Moreover, the carbon emissions are one of the main causes contributing to the global warming [ 45 ]. The keywords related to carbon occurred 212 times (8.72%). The high-frequency keywords related to carbon include ‘organic-matter’, ‘organic-carbon’, ‘activated carbon’, biochar, ‘dissolved organic-matter’, ‘black carbon’, etc. Since many countries hope to be carbon neutral by the middle of the twenty-first century, the carbon-related research will continue to increase in the next 30 years.

Emerging contaminants exist in various environmental media and are widely concerned because of its complex structure, easy enrichment, and high toxicity [ 20 , 58 , 60 ]. The frequency of emerging Organic pollutants was 164 times, accounting for 6.75%. The high-frequency keywords related to emerging contaminants constitute ‘polycyclic aromatic-hydrocarbons’, ‘pharmaceuticals’, ‘polychlorinated-biphenyls’, ‘microplastics’, ‘antibiotics’, etc. The research difficulties in emerging contaminant incorporated quantitative detection technology and influence mechanism on human health [ 7 , 20 , 32 , 60 ].

Pesticides are derivatives of agricultural production activities and have an important impact on food security [ 51 , 78 ]. The keywords related to pesticides occurred 140 times (5.76%). The common studied pesticide types include ‘glyphosate’, ‘atrazine’, ‘organochlorine’, etc. The promotion of organic agriculture and the development of biodegradable pesticides have alleviated pesticide pollution, but research on pesticides will continue for a long time due to the large area of arable land and the large amount of pesticide residues in arable soils, and also in estuarine areas that are conducive to pollutant accumulation [ 51 ], Masset et al., 2018; [ 78 ].

Most microorganisms in water bodies are harmless and essential to the normal functioning of the aquatic ecosystem, but there are also pathogenic microorganisms that can cause diarrhea, gastroenteritis, pneumonia, typhoid and other diseases [ 19 , 76 ]. The frequency of microorganism occurred 104 times (4.28%), including ‘bacteria’, ‘pathogens’, ‘escherichia-coli’, etc. The research on microorganisms related to NPS pollution is mainly focused on sewage, urban reclaimed water, and drinking water [ 19 , 76 ].

Regarding the top 20 most-cited articles, four publications were connected to nitrogen and phosphorus [ 57 , 61 , 62 , 47 ], while four articles were related to microplastics, antibiotics and heavy metals [ 20 , 32 , 37 , 60 ].

Agricultural NPS pollution and urban NPS pollution were the main pollution types

Regarding the 568 keywords with frequency more than 10, a total of 22 keywords related to NPS pollution types, which could be divided into three categories, including agricultural NPS pollution, urban NPS pollution, and natural runoff NPS pollution (Fig.  7 ).

figure 7

The co-occurrence map of keywords on the research of NPS pollution types during 2012–2021

Agricultural NPS pollution started earlier than urban NPS pollution [ 68 , 80 ]. Compared with urban NPS pollution, the agricultural NPS pollution involved a wider source area, and its process of migration and transformation was more complicated [ 61 , 67 ]. The frequency of agricultural NPS pollution was 354 times, accounting for 62.54%. The high-frequency keywords related to agricultural NPS pollution include ‘agricultural runoff’, ‘agricultural watersheds’, ‘paddy field’, ‘wheat’, ‘rice’, etc. Although agricultural NPS pollution has been studied for a long time, the pollutant source area determination, load calculation and risk assessment are still the focus of current research [ 57 , 65 ].

The urban NPS pollution has been widely concerned because of the rapid development of the urbanization [ 48 , 52 ]. The frequency of urban NPS pollution occurred 166 times (29.33%). The high-frequency keywords related to urban NPS pollution constitute ‘urban runoff’, ‘urbanization’, ‘highway runoff’, etc. The utilization of urban runoff in rainy season is a difficult research item for urban NPS pollution, particularly in arid areas [ 48 , 52 ].

Compared with agricultural NPS pollution and urban NPS pollution, the natural runoff NPS pollution received less attention. The frequency of natural runoff NPS pollution was 46 times, accounting for 8.13%. The high-frequency keywords related to natural runoff NPS pollution constitute ‘grassland’, ‘pasture’, ‘forest’, etc. Regarding the top 20 most-cited articles, eight publications were related to the agricultural NPS pollution, and three paper was related to urban NPS pollution (Table 1 ).

Land use change, rainfall and irrigation were the main driving factors of NPS pollution

Regarding the 568 keywords with frequency more than 10, a total of 16 keywords related to the main driving factors of NPS pollution, which could be divided into three categories, including land use change, climate change, and irrigation (Fig.  8 ).

figure 8

The co-occurrence map of keywords on the driving factors of NPS pollution research from 2012–2021

Land use changes caused by agricultural reclamation and urbanization accelerate the formation of NPS pollution [ 68 , 48 ]. The frequency related to land use change occurred 451 times, accounting for 51.13%. According to the World Bank database, the global population, arable land, urbanization rate raised from 30.3 × 10 8 to 73.4 × 10 8 , 1.28 × 10 9 hm 2 to 1.73 × 10 9 hm 2 , and 33–51%, respectively, during 1960–2015. The population growth increases the demand for agricultural land and urban land. Agricultural reclamation will enhance soil fertility and soil erosion risk, thus increasing the risk of NPS pollution [ 68 , 80 ]. Urbanization, on the one hand, will improve the surface impervious area and thus increase the runoff volumes and peak flow; on the other hand, the growth of human activities will increase the pollutant emissions [ 48 , 52 ].

Climate change, especially rainfall and snowmelt, is the main carriers of NPS pollutants. The first flush is the main source of urban NPS pollution [ 50 , 48 ]. Climate warming is an important global environmental problem. The frequency of climate change was 386 times, accounting for 43.76%. The high-frequency keywords related to climate change include ‘rainfall-runoff’, ‘1st flush’, ‘rainfall intensity’, ‘stormwater runoff’, etc. The global land temperature increased at a rate of 0.32 °C per decade from 1981 to 2019 [ 64 ]. The global warming may cause extreme rainfall, which will produce more NPS pollution load and increase the control difficulty of NPS pollution [ 48 , 45 ].

Irrigation is the key factor formatting agricultural NPS pollution. The frequency of irrigation was 45 times, accounting for 5.10%. Although the application of water-saving irrigation equipment alleviates NPS pollution caused by irrigation, it is still a difficult problem to effectively control NPS pollution caused by the recession of paddy field [ 22 , 53 ].

Load calculation and integrated management were the key points of NPS pollution technology research

In terms of the 568 keywords with frequency ≥ 10 times, a total of 69 keywords related to the key points of NPS pollution technology research, which could be divided into five categories, including monitoring and identification, load calculation, risk assessment, control technology and integrated management (Fig.  9 ).

figure 9

The co-occurrence map of keywords on the technology research of NPS pollution during 2012–2021

Monitoring and identification of NPS pollutants is the basis for the control and management of NPS pollution. The frequency of keywords related to monitoring and identification was 361 times, accounting for 15.30%. The high-frequency keywords constitute ‘monitoring’, ‘identification’, ‘stable isotopes’, ‘source apportionment’, ‘microbial source tracking’, ‘indicator bacteria’, etc. The water quality and quantity obtained based on the automatic monitoring platform can be directly used to calculate the NPS pollution load in the catchment units, it is the most direct method to characterize NPS pollution. However, the high cost of simultaneously monitoring water quality and quantity hinders the development of the automatic monitoring system [ 77 ]. Additionally, the rapid identification of priority contaminants among mixed pollutants, particularly for emerging pollutants, is also a focus for future water contamination monitoring [ 4 , 5 ]. The source identification technology based on the isotopic of nitrogen and oxygen, the three-dimensional fluorescence spectrum, and indicator bacteria is helpful for quantitative analysis of NPS pollution. How to correct the influence of nitrification and denitrification on isotopic abundance and the overlap and scattering of spectral peak, and isolating the highly identifiable fecal indicator bacteria are key for the traceability accuracy improvement [ 34 , 41 , 59 ].

Load calculation can provide important data support for the control and management of watershed water quality. The frequency of keywords related to load calculation occurred 769 times (32.58%). The high-frequency keywords include ‘SWAT’, ‘AGNPS’, ‘export coefficient model’, ‘SWMM’, ‘remote sensing’, ‘GIS’, etc. USA is the pioneer in developing the load calculation model of NPS pollution, the export coefficient model, SWAT (Soil and Water Assessment Tool), AGNPS (Agricultural Non-Point Source), and SWMM (Storm Water Management Model) were all developed by USDA ARS and US EPA [ 1 , 83 , 87 ]. The export coefficient model is easy to operate, but it cannot describe the pollutant migration process [ 26 ]. SWAT, AGNPS, and SWMM can be used for the mechanism simulation at watershed scale and often combined with 3S technology ‘RS、GIS、GPS’ [ 1 , 87 ]. SWAT model is used to simulate the long-term effects of soil, land use and management practices on runoff, sediment load, and agricultural chemical transport in a large-scale watershed [ 1 , 87 ]. AGNPS model is used to analyze the impact of agricultural management practices, soil and water conservation methods, land use and tillage practices on agricultural NPS pollution [ 1 , 83 ]. SWMM model is used to simulate the process of urban rainfall, runoff and pollutant movement [ 1 , 83 ]. These models have abundant application cases in the USA, while in other countries, how to localize the model parameters is the key to upgrade model simulation accuracy [ 1 , 83 , 87 ].

Risk assessment is an important tool for assessing the severity of NPS pollution. The frequency of keywords related to risk assessment was 207 times, accounting for 8.77%. The high-frequency keywords constitute ‘environmental risk’, ‘health-risk’, ‘quality assessment’, ‘soil and water assessment tool’, ‘water assessment-tool’, etc. Load calculation model, Source identification technology, and water quality index assessment method were the most common assessment tools for NPS pollution [ 1 , 41 , 85 ]. Most risk assessment methods were focused on the single pollutant of soil and water, the integration of a comprehensive assessment method for multiple chemical and biological contaminants, and the impact of NPS pollutants on human health risk is a future research focus [ 5 , 41 ]. It is worth noting that the construction for ecological thresholds of toxicological concern is conducive to the environmental hazard assessment and the selection of pollutant control technology [ 10 ].

Control technology is the key to controlling NPS pollution. The frequency of keywords related to control technology was 388 times, accounting for 16.44%. The high-frequency keywords constitute ‘best management practice’, ‘constructed wetland’, ‘buffer strips’, ‘riparian buffer’, ‘vegetative filter strips’, ‘nanoparticles’, etc. Nanomaterials have potential applications in NPS pollution control due to its high adsorption properties [ 3 ]. The best management practices (BMPs) constructed by Wright Water Engineers of USA played an effective role in the control of NPS pollution, including more than 300 NPS pollution control measures for engineering and non-engineering [ 88 ]. Constructed wetland, buffer strips, riparian buffer, and vegetative filter strips are commonly used engineering measures in BMPs, focusing on the interception of NPS pollution transmission process and the treatment of received soil and water [ 73 , 44 , 81 ]. In Europe, more than 30 countries launched the Costaction 869 program in 2005, establishing a cost–benefit assessment database for surface water and groundwater nutrients, including nutrient management, farmland management, fertilizer application management, etc. (Panagopoulos et al., 2011). Similarly, [ 84 ] proposed the Reduce–Retain–Reuse–Restore (4R) Theory and Technology, which has clarified the overall idea and integrated application framework of technology for agricultural NPS pollution control, and achieved good practice in China. The LID practices have been widely used in urban rain and flood integrated management, that aims to integrate storm water management into urban green infrastructure system [ 31 ]. To sum up, sustainable control technologies based on ecological restoration measures is a hotspot in the research of NPS pollution control technology.

Integrated management is not only an important driving force to solve the NPS pollution, but also an important guarantee for the research on monitoring, source identification, and control technology [ 14 , 67 ]. The frequency of keywords related to integrated management occurred 635 times (26.91%). The high-frequency keywords include ‘catchment management’, ‘governance’, ‘nutrient management’, ‘policy’, ‘water governance’, ‘water management’, etc. The USA and EU have abundant practices in national management of NPS pollution. The USA formulated the first NPS pollution control law in 1936, which made clear provisions for the improvement of rural environmental quality. The CWA (1972) is an important guidance and guarantee for the control of NPS pollution in the USA. The CWA set the ground rules for controlling sewage discharges in the USA, and raised the Rural Clean Water Program by implementing BMPs to control soil erosion and reduce agricultural NPS pollution. The Water Quality Act of 1987 officially defined the agricultural NPS pollution, and systematically divided various types of agricultural NPS pollution. The Environmental Quality Incentives Program (EQIP) was established in the ‘Federal Agriculture Promotion and Reform Act’ of 1996. This program aims to achieve the dual goals of improving agricultural production and environmental quality by providing financial and technical support for producers. Meanwhile, the WPA, National Irrigation Water Quality Program, and Total Maximum Daily Load (TMDL) have made great contributions to controlling NPS pollution in the USA. In the EU, the DWD (1980), Nitrate Directive (1991), and WFD (2000) have promoted the control of regional NPS pollution. China has carried out the most research on NPS pollution in the past decade. China has issued many laws, regulations, and guidelines for controlling NPS pollution, including the EPL (1989), Agricultural Law (2002), WPCL (2008), and YRPL (2020), etc. The utilization rate of chemical fertilizer and pesticides in China was 40.2% and 40.6% for the major crops of rice, wheat and corn, increasing 5 and 4 percent from 2015 to 2020 (MOA [ 49 ]. The control of NPS pollution in China is nearly 20 years behind developed countries. It is likely to be a hot issue in the next decade as the pollution situation is still serious. Currently, how to evaluate the impact of policy implementation on the local government and improve farmers’ awareness of pollution control is a challenge for the management of NPS pollution in China.

The research locations were mainly concentrated in surface water and groundwater, but the ocean and drinking water might be the future research focuses

As for the 568 keywords with frequency ≥ 10, a total of 34 keywords connected to NPS pollution research objects, which could be divided into five categories: surface water, groundwater, drinking water, wastewater and seawater (Fig.  10 ).

figure 10

The co-occurrence map of keywords on the research locations of NPS pollution from 2012–2021

Surface water and groundwater in land areas are the main receiving waters of NPS pollution, which are most affected by agricultural production, human activities, mining, etc. [ 47 , 68 ]. The frequency of keywords related to the surface water and groundwater were 627 and 190 times, accounting for 50.61% and 15.33%, respectively. The high-frequency keywords include ‘agricultural runoff’, ‘highway runoff’, ‘subsurface drainage’, ‘shallow groundwater’, etc. The pollutants with high attention in agricultural surface water includes nitrogen, phosphorus, organic matter, and pesticides, while in urban surface water, it constitutes heavy metals and emerging contaminants [ 16 , 68 , 17 , 75 ]. Additionally, nitrate is the high-concern pollutant in the shallow groundwater of agricultural areas, and heavy metals is the main pollutant in mining area [ 57 , 17 ].

Wastewater has a high concentration of contaminants. The frequency of keywords related to wastewater was 194 times (15.66%). Wastewater is usually discussed as PS pollution and easily controlled. It is worth mentioning that the overflow of wastewater during rainstorms is a research focus of NPS pollution [ 35 ].

Considering most surface water and groundwater will eventually flow into the ocean, the seawater, especially the coastal waters and bay area, was the key area for the control of NPS pollution [ 25 , 33 ]. The frequency of keywords related to the seawater was 126 times (10.17%). The high-frequency keywords constitute ‘Baltic Sea’, ‘Chesapeake Bay’, ‘coastal waters’, ‘bay’, etc. Ocean plastic waste is listed as a global urgent problem. It is estimated that 4.8- 12.7 million tons of plastic waste enters the ocean from coastal areas around the world each year [ 33 ]. The plastic waste is difficultly degraded in the ocean, then causing serious impact on the health and safety of Marine life and human beings [ 33 ].

Drinking water was also a key area as it is closely related to humane health [ 8 ]. The frequency of keywords related to drinking water was 102 times, accounting for 10.17%. The high-concern contaminants in drinking water include nitrate, Helicobacter pylori , chlorinated disinfection by-products, additionally, microplastics have received wide attention in recent years [ 21 , 66 ]. Most urban areas have a complete drinking water security system, while rural areas have higher drinking water safety risks due to their primitive technology and remote location, particularly in the poor areas of developing countries [ 21 , 66 ].

3407 articles related to NPS pollution were published in SCI-EXPANDED and SSCI between 2012 and 2021. Professor Wei Ouyang from Beijing Normal University took the highest number of articles (55) and H-index (19). Chinese Academy of Sciences published the highest number of articles (304). Sci. Total Environ , Environ. Sci. Pollut . Res and Water were the most productive journals.

According to the keywords analysis of the NPS pollutant, the pollution types, the main driving forces, the research technology and the research object. The traditional NPS pollutants of nitrogen, phosphorus, and heavy metals took the highest concern; emerging contaminants have attracted rising attention in the past ten years. Research on NPS pollution types and the main driving forces are closely related, the migration and transformation of agricultural NPS pollution and urban NPS pollution driven by irrigation and land use change were the research hot issues. Regarding the research technology, load calculation and integrated management were the hotspots related to NPS pollution technology research. The combination of 3S technology (RS, GIS, and GPS) and NPS pollution models, the sustainable control technologies, the technology of accurate traceability and automatic monitoring, and the comprehensive management plan were the key points of NPS pollution technology research in the past decade. In addition, the research objects were mainly focused on the surface water and groundwater, while the ocean and drinking water were also a key area related to NPS pollution.

It is worth noting that developing countries, including China, have been severely affected by NPS pollution over the past decade. While in developed countries, most of them have made great progress in controlling NPS pollution. They have comprehensive pollutant monitoring network, strict law enforcement system, mature technology library for controlling NPS pollution, and operational economic compensation measures to improve farmers’ enthusiasm in preventing NPS pollution. Considering that developing countries will be the major areas for controlling NPS pollution, these experiences can provide important guidance for controlling NPS pollution in developing countries.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


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National Water Quality Program

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  19. Water Pollution

    Water Pollution: A literature review. The following review attempts to understand water pollution from a chronological perspective, representing the shift in sources of pollutants, namely from purely examining sewage to the contemporary issues of microplastics before recognising the research of naturally occurring factors affecting the overall ...

  20. Chapter 2 Literature Review on River Water Quality Parameters and

    2.1 Purpose. This chapter aims to determine the current state of knowledge on river pollution management by discussing relevant water quality parameters and their significance in relation to river pollution assessment. It also reviews available policy instruments for river pollution management to better understand their implications.

  21. Radioactive waste: A review

    The reviewed papers presented here provide a general overview of worldwide radioactive waste-related studies conducted in 2019. The current review includes studies related to safety assessments, decommission and decontamination of nuclear facilities, fusion facilities, and transportation. Further, the review highlights radioactive wastewater ...

  22. Literature Review Water Pollution

    Fraser 32 reviewed much of the literature, through about 1970, on the effects of regu lated stream discharge on aquatic resources. Hunt and Jones 33>34 investigated the lit toral fauna of two Welsh reservoirs that had severe (up to 5.5 m) water level fluc tuations. In both reservoirs, the numbers and variety of littoral invertebrates were re

  23. Tackling microplastics pollution in global environment through

    As water pollution by MPs is complex, managing it effectively requires their responses through the utilization of technology, policy instruments, and legislation. It is evident from a literature survey of 228 published articles (1961-2023) that existing water technologies are promising to remove MPs pollution.

  24. Water Pollution Literature Review

    Water Pollution Literature Review. 2230 Words9 Pages. Introduction. Many of South Africa's rivers are polluted in some way and are a health risk if consumed by a human. The pollution occurs from all the urban development as well as rural development. Often in rural areas the water isn't cleaned so many people fall sick and the government ...

  25. Climate Change, Air Pollution, and Human Health in the Kruger to

    There is a 50% possibility that global temperatures will have risen by more than 5 °C by the year 2100. As demands on Earth's systems grow more unsustainable, human security is clearly at stake. This narrative review provides an overview and synthesis of findings in relation to climate change, air pollution, and human health within the Global South context, focusing on case study geographic ...

  26. Nonpoint source nutrient pollution: Science needs for Water Quality

    Nonpoint source nutrient pollution: Science needs for Water Quality Monitoring On this page: Overview; This presentation will review the latest research on inputs, budgets, effects, legacies and management related to non-point source nutrient pollution. Using examples of nitrogen and phosphorus budgets at the national, regional and local scales ...

  27. Agriculture

    Plastic film mulching (PFM) technology plays an important role in agricultural production in "drought and cold" regions, and macroplastics pollution in farmland has become a major concern affecting the sustainable development of regional agricultural production. However, there remains a lack of research on the effects of film application and macroplastics characteristics on soil nutrients ...

  28. Recent advances in acid mine drainage treatment through hybrid

    Industrial activities have surged in recent years, resulting in severe environmental and human health consequences. Coal mining, in particular, has emerged as a major contributor to environmental degradation, notably through water pollution. Acid Mine Drainage (AMD) refers to the contaminated water generated by mining operations, characterized by low pH levels and high concentrations of heavy ...

  29. Unit 8 Aquatic and Terrestrial Pollution AP Exam Review Packet

    Unit 8 Aquatic and Terrestrial Pollution APES Exam Review Sources of Pollution 1) Fill in the table below comparing point and non-point sources of pollution. Point Pollution Source Non-point Source Define to a single, identifiable source of a pollutant diffused and can therefore be difficult to identify, Examples Smokestack, waste dishcharge pipe Pesticide spraying, urban or farm runoff Human ...