Publications

The Effect of Non-Fluoride Factors on Risk of Dental Fluorosis: Evidence from Rural Populations of the Main Ethiopian Rift

Elevated levels of fluoride in drinking water is a well-recognized risk factor of dental fluorosis. In this study, published in the journal Science of the Total Environment, authors found flouride to be strongly associated with dental fluorosis in a sample of over 1000 individuals living in several rural communities in the Ethiopia. Age, sex, SSSF, and milk consumption were found to correlate with dental fluorosis outcomes, both as independent factors and through modification of the effects of flouride. In addition, several other elements in water were significantly associated with dental health in the study area, suggesting the possibility that dental fluorosis may be related to multiple contaminant exposures. Additional research is warranted to more effectively isolate these effects, and to understand the mechanisms by which they operate.

Freshwater, Climate Change and Adaptation in the Ganges River Basin

Climate change is one of the drivers of change in the Ganges river basin, together with population growth, economic development and water management practices. These changing circumstances have a significant impact on key social and economic sectors of the basin, largely through changes in water quantity, quality and timing of availability. This paper evaluates the impact of water on changing circumstances in three sectors of the Ganges basin: agriculture, ecosystems and energy. Given the inherent interconnectedness of these core sectors and the cross-cutting impact of changing circumstances on water resources, we argue that adaptation should not be viewed as a separate initiative, but rather as a goal and perspective incorporated into every level of planning and decision making. Adaptation to changing circumstances will need to be closely linked to water resource management and will require significant collaboration across the sectors.

Groundwater Quality and Its Health Impact: An Assessment of Dental Fluorosis in Rural Inhabitants of the Main Ethiopian Rift

Increased intake of dietary calcium may be key to addressing widespread dental health problems faced by millions of rural residents in Ethiopia’s remote, poverty-stricken Main Rift Valley, according to a new Duke University-led study published in the journal Environment International. As many as 8 million people living in the valley are estimated to be at risk of dental and skeletal fluorosis as a result of their long-term exposure to high levels of naturally occurring fluoride in the region’s groundwater. Most efforts to combat fluorosis in the region have focused primarily on treating drinking water to reduce its fluoride content. Increasing the amount of calcium in villagers’ diets, or finding alternative sources of drinking water may be necessary in addition to these fluoride-reducing treatments, the study found. Support came from the Duke Global Health Institute and Duke’s Nicholas Institute for Environmental Policy Solutions.

A Silent Tsunami Revisited: Extending Global Access to Clean Water and Sanitation

While billions still lack safe drinking water and sanitation, access can be enhanced through improved policy and strategic outreach, according to this report by Duke University's Nicholas Institute for Environmental Policy Solutions and the Aspen Institute. A Silent Tsunami Revisited outlines the progress made on the expansion of water, sanitation and hygiene (WASH) services since its companion report was released in 2005. It highlights these experts' recommendations for improving the efficacy of the WASH sector and achieving universal access to safe water and sanitation.

Freshwater Ecosystem Vulnerability Assessment: The Indrawati Sub-Basin, Nepal

This report is part of a project of WWF Nepal and the Nepalese Water and Energy Commission Secretariat (WECS). It outlines the discussions and conclusions of three workshops held in Nepal to determine the vulnerability of the Indrawati sub-basin to the impacts of climate change and development within the context of climate change vulnerability at the national level. Held over the course of four days in Kathmandu and in the Sindhupalchok district headquarters of Chautara, the workshops brought together a diverse group of more than 60 participants, including Nepali national experts, local bureaucrats, and most importantly, local water users and subsistence farmers with direct knowledge of resource management issues in the basin.

A Review of U.S. Efforts in Water and Sanitation

Access to safe water and sanitation has expanded significantly around the world in recent years, in part because of efforts by the United States, which has been increasingly active in the water, sanitation, and hygiene (WASH) sector through engagement by the government, foundations, NGOs, faith-based organizations, academia and the private sector. The Nicholas Institute for Environmental Policy Solutions at Duke University has assessed the momentum, funding and effectiveness of this engagement since 2005, when the Nicholas Institute and the Aspen Institute held a forum on WASH challenges. This report references recommendations from that forum and presents the results of recent structured interviews with over 45 stakeholders active in the WASH sector. These stakeholders provided invaluable insights on what has been achieved, what has changed, and what requires attention. Particular consideration was given to the efforts of the U.S. government (USG).

Climate Change Impacts and Adaptation in Nepal

The impacts of climate change on water resources will have wide-reaching implications for agricultural systems and food security around the globe. This is especially true for Nepal, a poorly developed country where a high percentage of the population is dependent on agriculture for its livelihood. It is thus crucial for Nepal’s leaders and resource managers to draft and begin implementing national adaptation plans. This working paper aims to create a more comprehensive understanding of how these impacts will be realized at different scales in Nepal, from household livelihoods to national food security, and the many institutions governing the ultimate adaptation process. It concludes with potential solutions for how the country can overcome the many hurdles it faces in the adaptation process as it continues to develop.

Better Health through Improvements in Water and Sanitation

While significant progress has been made towards addressing the challenge of providing basic water access, there are still nearly one billion people who lack convenient access to safe water, most of them in sub-Saharan Africa and South and East Asia. Furthermore, over two and a half billion people in the world lack access to adequate sanitation. This brief examines an integrated approach of water, sanitation, and hygiene which will maximize health impacts.

Assessing Climate Change Risks, Vulnerabilities, and Responses in the Siphandone/Stung Treng Area with a Focus on Protecting Vulnerable Ecosystems

This workshop report reflects discussions and analysis conducted by 16 regional experts who gathered to test the methodology outlined in Flowing Forward with reference to the Siphandone/Stung Treng area in the Mekong River basin. The findings presented here highlight the significant effects of both climate change and development pressures on ecosystems and livelihoods in the case study area and discuss the ongoing and potential future policy and infrastructure responses to changing circumstances.

Water and Agriculture: Implications for Development and Growth

Essays from the CSIS and SAIS Year of Water Conference