Investigating the link between Drinking Water Quality and Chronic Kidney Disease in Jalisco, Mexico

By Kaitlyn Jackson

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Kaitlyn at the biology laboratory of the Instituto Tecnológico y de Estudios Superiores de Occidente (ITESO), analyzing water sample results for total coliform bacteria and E. coli. Yellow bottles indicate positive for total coliforms. (Photo courtesy of Kaitlyn Jackson.)

Notes from the Field: Student Research in Latin America
CLAS awards financial support to graduate students to travel to Latin America for pre-dissertation research. The following is a reflection on one student’s summer fieldwork experience. (For more information, please see CLAS Summer Field Research Grants.)

Mexico is currently facing a public health crisis in chronic diseases. The Institute for Health Metrics and Evaluation (IHME) most recent data for Mexico (2017) shows that chronic kidney disease (CKD) is the second largest factor in Disability Adjusted Life Years (DALYs), a metric that combines deaths and disability. This trend has held constant since 2007. In 2016, non-communicable diseases (NCDs) were responsible for 80% of the countrywide deaths in Mexico, with diabetes and heart disease accounting for 40% of all NCD-related deaths. Chronic Kidney Disease in Mexico causes 25% of deaths related to diabetes and 28% related to heart disease. Hospital admissions for patients under the age of 25 suffering from CKD have skyrocketed, tripling in some areas of Mexico in the last five years.

Concurrently, over-exploitation of Lake Chapala, Mexico’s largest freshwater reservoir, has resulted in a serious water crisis. The state and federal water authorities continue to utilize this precious resource for drinking water, agriculture, and industry, and continue to develop infrastructure in response to increasing urban and agricultural demands. Lake Chapala provides sixty percent of the drinking water to Guadalajara, a city with a population of over four million. Not only have population growth and agricultural demands depleted Lake Chapala’s water levels, which in turn lowers water quality, but also the Santiago River, which is fed by Lake Chapala, contains an estimated 1,090 toxic pollutants. Inhabitants of rural communities such as Mezcala, San Pedro Itzicán, and the small city of Chapala are suffering from epidemic rates of CKD, especially in young adults and adolescent populations. This is highly unusual, as CKD typically affects older adults or those with diabetes.

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Children playing in Chapala, Jalisco, Mexico. (Photo courtesy of Kaitlyn Jackson.)

Chronic diseases place a burden on both individuals and healthcare systems, and hinder economic growth, highlighting our purpose in investigating all risk factors of CKD, including drinking water quality, access, and consumption behavior. Under the guidance of Professor Charlotte Smith, we set out to unravel the mystery behind this drastic rise in CKD within the rural and primarily indigenous communities Mezcala and San Pedro Itzicán, as well as in Chapala, one of the more prominent cities within the region of the Chapala Lake basin.  

Beginning in January 2019, our research team formed a collaborative partnership with the Instituto Tecnológico y de Estudios Superiores de Occidente (ITESO) to develop a mixed-methods study to collect preliminary data in Mezcala, San Pedro Itzicán, and Chapala, under the framework of the 6th Sustainable Development Goal — access to safe water as a human right. Over the last five years, ITESO has built extensive and trusted relationships in the three communities mentioned above. A strong alliance was built combining ITESO’s expertise in hydrology and engineering and UC Berkeley’s in drinking water exposures and public health.

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The town of San Pedro Itzican from above on the shores of Lake Chapala. (Photo courtesy of Kaitlyn Jackson.) 

Between May and August 2019, we conducted 99 household surveys, 12 key informant interviews, and 6 focus groups regarding perceptions of drinking water, health behaviors, exposure to environmental and occupational contaminants, and relevant disease history. Through 15 key informant interviews with religions leaders, local non-profits, municipal government employees, indigenous leaders, and distinguished academics with knowledge and experience working in the Jalisco region of Mexico, we gained insight and built the trust which allowed us to return each and every week.

Because chronic disease exposures are more complex than acute diseases like diarrhea, and often involve multiple exposures as well as genetic predispositions, we conducted a project to both amplify the local voices who had previously been silenced and ignored, and additionally share collected information to give these vulnerable populations the tools to call for action. Organizing focus groups with volunteer brigade members, youth leadership organizations, fisherman unions, families suffering the severity of a CKD diagnosis, and the board members of an indigenous community group allowed for us to have extended conversations with diverse groups of people, to hear first-hand of their lived experiences. Elderly participants gazed into the distance with a forlorn look in their eyes, describing a time when, as children, they swam, drank, bathed, and played in Lake Chapala. When we gazed out into the vast hazy green lake, our research team listened as these same participants described with disgust the decline of the lake’s health over the last 20 years. No one dares to take a swim these days.

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The community church located in the town square of Mezcala, located on the banks of Lake Chapala. (Photo courtesy of Kaitlyn Jackson.)

Simultaneously, our team collected data on drinking water quality, food consumption, and occupational and lifestyle behaviors. We tested water quality in participating households, measuring levels of arsenic, copper, nitrate, nitrite, total chlorine, free chlorine, and the presence or absence of total coliforms and E. coli. Primary drinking water sources included purchased 20-liter garrafones from local manufacturers, tap water, and rooftop water tanks. Water quality testing for environmental and microbial contaminants allowed for comparisons between water quality perceptions and reality. After analysis, members of our research team will return to Mezcala, Chapala, and San Pedro Itzicán to deliver individual participant results, as well as workshops to discuss and interpret the importance and meaning of each and every result.

It was tragic to meet mothers, brothers, sisters, and daughters, all of whom either had or knew someone dying of kidney failure. Seeing this first-hand has motivated our research team to continue forward with our project in a way that directly benefits the involved communities. Following the lead of our collaborators at ITESO, we have agreed to assist in the production and content of a documentary to spread awareness throughout Jalisco and Mexico about this public health crisis. We have begun to analyze our dataset using geospatial statistical methods. Preliminary results suggest that inhabitants of the Lake Chapala basin face significant structural barriers in accessing safe drinking water. We hope that our results from this study will support calls for action by local communities during this water crisis. The knowledge gaps surrounding the true CKD burden, in tandem with a growing local water crisis and decreasing water quality, highlights the need for increased attention to Lake Chapala and the need for access to clean drinking water. The hope is that by synthesizing public health research with community participation, we can provide these vulnerable populations with the strength and confidence to seguir adelante.

KaitlynJackson-250pKaitlyn Jackson will be graduating with her MPH from the UC Berkeley School of Public Health Global Health & Environment program this May. A backpacking fanatic from the Pacific Northwest, Kaitlyn’s passion for Spanish was born while spending two weeks living in a coffee farming community in the Dominican Republic when she was 15 years old. This passion led her all the way to Santiago, Chile, where she spent three years working for two social impact organizations. Kaitlyn’s dedication for global public health stems from her desire to focus on enhancing the lives of the most vulnerable and underserved through public health solutions grounded in data driven evidence. In her free time, you can find Kaitlyn experimenting in the kitchen with spices from across the globe or walking her black lab, Layla. Kaitlyn is a recipient of the 2019 CLAS Summer Field Research Grant. 

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A photo of a household water sample directly taken from the tap. Yellow indicates coliform bacterial contamination. Two live mosquito larvae were also detected. (Photo courtesy of Kaitlyn Jackson.)
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Drinking water well pump in San Pedro Itzican. This pump pulls water from a thermal underground water source. The pipes of this well are therefore scalding hot to the touch, due to the high natural water temperature. A pigpen is located next to the well.  (Photo courtesy of Kaitlyn Jackson.)

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The author conducting a focus group with fisherman and fishing families in the town of Mezcala. (Photo courtesy of Kaitlyn Jackson.)

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