Water quality and chronic kidney disease of unknown aetiology (CKDu) in the dry zone region of Sri Lanka: impacts on well-being of village communities and the way forward.

There has been a growing concern in the dry zone of Sri Lanka that the contaminated surface and ground waters and ecohydrological changes are possibly linked to a number of health issues and overall well-being of village communities, including the widespread renal failure termed as chronic kidney disease of unknown aetiology (CKDu). Two types of data were collected for this study, namely qualitative data from key informant interviews and abstracts of 33 peer-reviewed research articles during the past decade. A total of 35 key informants were recruited, mainly from communities in the northern dry zone region where a higher number of CKDu patients have been reported. The interview transcripts were examined using a range of techniques including content, thematic and semantic network analyses. The findings of the research articles were explored through a word cloud analysis. The study indicates that CKDu seems to be influenced by multifactorial ecohydrological changes linked to anthropogenic stressors such as inefficient use of fertilisers and weedicides in agriculture. This situation is made further complicated by factors such as high fluoride level and hardness of local groundwater. Inappropriate agricultural and water policies and poor governance are other factors, particularly little or no restriction on the use of agrochemicals and pumping of groundwater and limited access to clean municipal water supplies. The key informants indicated grave concerns on the flow on effects of poor surface and groundwater quality in the region on health, livelihood and well-being of communities. There are also inevitable economic implications such as loss of human capital and families losing assets to pay for ongoing health issues. The study highlighted the need for more in-depth research to better understand how the surface and groundwater quality influence CKDu and other health conditions in the region. Furthermore, there is a need for implementing an active water quality management strategy with emphasis on developing locally relevant guidelines, educational programmes and integrated heath monitoring programmes in the region.