International Journal of Environmental Research and Public Health Article Drinking Water Investigation of Hill Tribes: A Case Study in Northern Thailand Suntorn Sudsandee 1,* , Krailak Fakkaew 1, Vivat Keawdounglek 1, Pussadee Laor 1, Suwalee Worakhunpiset 2 and Tawatchai Apidechkul 1,3 1 Environmental Health Program, School of Health Science, Mae Fah Luang University, Chiang Rai 57100, Thailand; [email protected] (K.F.); [email protected] (V.K.); [email protected] (P.L.); [email protected] (T.A.) 2 Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; [email protected] 3 Center of Excellence for the Hill-tribe Health Research, Mae Fah Luang University, Chiang Rai 57100, Thailand * Correspondence: [email protected] Received: 25 January 2020; Accepted: 29 February 2020; Published: 5 March 2020 Abstract: Hill tribes are a group of people who live in remote areas in northern Thailand. They typically use untreated water for drinking, that can lead several health problems. The six main hill tribes—Akha, Hmong, Karen, Lahu, Lisu, and Yao—were selected for the study. A validated questionnaire was used for data collection. Water samples were collected from the selected villages and tested for the quality at Mae Fah Luang University, Thailand. Results: the major sources of drinking water were mountain water supplies (74.3%), and commercial bottled water (21.4%). Easy access, sufficiency for the whole year, and food-drug administration sign labeled were the criteria used for selecting sources of drinking water. Colorless and safety were also used as a selection criteria for their drinking water in some tribes. Lisu, Karen, and Hmong treated their drinking water by boiling, while Akha and Lahu stored the water in certain containers to allow particle settling before drinking water without treatment. 42.0% of the water samples had a turbidity values <5 NTU, and total coliform and fecal coliform bacteria were detected in 100.0% of the samples. To prevent water-borne diseases among the hill tribe people, appropriate water treatments such as boiling, filtration, and disinfection are recommended. Keywords: hill tribes; mountain water supply; drinking water; turbidity; biological parameters 1. Introduction Adequate and safe water supply, especially drinking water, must be available for all people, which can result in a benefit to health and boost countries’ economic growth as well as contribute greatly to poverty reduction. In 2017, about 5.3 billion people had access to safely managed drinking-water services, but the remaining 2.2 billion people still do not have that access. The United Nations (UN) and World Health Organization (WHO) found that more than 40.0% of the global populations did not have access to sufficient clean water, and the WHO estimated that 144 million people are collecting and using untreated surface water from lakes, ponds, rivers and streams. Specifically, people who live in mountainous area, especially in low-income countries, informal, or illegal settlements usually have less access to safe drinking water than other residents [1–3]. Globally, the lack of access to safe drinking water and sanitation accounted for 88.0% of all deaths from diarrheal disease, especially in children under five years [4,5]. Drinking water contamination originates from human and animal wastes from defecation close to water sources [6], cross-contamination from sewage lines [7], sewage disposal Int. J. Environ. Res. Public Health 2020, 17, 1698; doi:10.3390/ijerph17051698 www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2020, 17, 1698 2 of 13 without treatment and leakage from septic tanks or pit latrines [4]. Globally, at least 2 billion people used drinking water sources contaminated with feces [2]. In Thailand, drinking water contamination by microorganisms has been recognized as a major problem. Several microorganism contamination consequences have been reported such as severe diarrhea, dysentery, hepatitis A, and intestinal parasitic infections [8–11]. ImprovingInt. J. Environ. access Res. Public to Health safe 20 drinking20, 17, x FOR waterPEER REVIEW can eventually benefit human health by2 reducing of 12 the risk of water-borne infectious diseases [3,12,13]. In Thailand, the Provincial Waterworks Authority (PWA) andGlobally, the Metropolitan at least 2 billion Waterworks people use Authorityd drinking water (MWA) sources are thecontaminated major organizations with feces [2]. that In produce Thailand, drinking water contamination by microorganisms has been recognized as a major problem. and distribute the water supply to households. The general water treatment system begins with raw Several microorganism contamination consequences have been reported such as severe diarrhea, water undergoingdysentery, hepatitis coagulation A, and and intestinal flocculation, parasitic infections sand filtration, [8–11]. and disinfection. After these processes, the treated waterImproving is then access distributed to safe drinking to the water consumers can eventually [14 –benefit16]. However, human health the by PWA reducing and the the MWA servicesrisk do notof water cover-borne the infectious whole area diseases of Thailand. [3,12,13]. In They Thailand, manage the Provincial and source Waterworks clean waterAuthority only to the people living(PWA) in and the the big Metropolitan cities and municipal Waterworks areas, Authority while, (MWA) people are in the rural major areas, organizations especially that in hill tribe produce and distribute the water supply to households. The general water treatment system begins villages, are out of the service zones of both the PWA and the MWA. with raw water undergoing coagulation and flocculation, sand filtration, and disinfection. After these Mostprocesses, hill tribe the treated villages water are is located then distributed in the to mountainous the consumers [14 areas–16]. in However, Northern the PWA Thailand. and the The hill tribes inMWA Thailand services are d dividedo not cover into the whole six main area groups:of Thailand. Akha, They manage Hmong, and Karen, source Lahu,clean water Lisu, only and to Yao [17]. They havethe migratedpeople living from in the the big southerncities and municipal part of Chinaareas, while, into people Thailand in rural in recentareas, especially decades. in hill Since 2012 approximatelytribe villages, 800,000 are hillout of tribe the service people zones live inof both Thailand the PWA [18 and]. Each the MWA. tribe group has their own language, Most hill tribe villages are located in the mountainous areas in Northern Thailand. The hill tribes culture, and beliefs, which are different from those the Thai people. Most hill tribes live in the in Thailand are divided into six main groups: Akha, Hmong, Karen, Lahu, Lisu, and Yao [17]. They mountainoushave migrated border areas from ofthe the southern 16 northern part of provinces China into in Thailand.Thailand in In recent 2012, decades. 180,214 hillSince tribe 2012 members lived in 652approximately villages in800,000 Chiang hill tribe Rai people Province live in [17 Thailand] where [18]. elevations Each tribe rangegroup has from their 405–1300 own language, m above sea level (MASL).culture, Theand villagesbeliefs, which are generallyare different outside from those the the service Thai people. areas ofMost the hill PWA. tribes This live studyin the aims to investigatemountainous the system border of drinkingareas of the water 16 northern management, provinces andin Thailand. detect itsIn quality,2012, 180,214 including hill tribe assessing members lived in 652 villages in Chiang Rai Province [17] where elevations range from 405–1300 people knowledgemeters above and sea level practices (MASL). relevant The villages to their are generally daily drinking outside the water service consumption. areas of the PWA. This study aims to investigate the system of drinking water management, and detect its quality, including 2. Materialsassessing and people Methods knowledge and practices relevant to their daily drinking water consumption. 2.1. Study2. SitesMaterials and Methods Six major2.1. Study hill Sites tribes; Akha, Hmong, Karen, Lahu, Lisu, and Yao, living in mountain areas of Chiang Rai Province, northern Thailand, were selected. The study sites are shown in Figure1. The Karen and Six major hill tribes; Akha, Hmong, Karen, Lahu, Lisu, and Yao, living in mountain areas of Lahu villagesChiang are Rai located Province, the northern center Thailand, of Chiang were Rai selected. Province, The study while sites the are Akha, shown Yao in andFigure Lisu 1. The villages are located alongKaren and the Lahu Thailand-Myanmar villages are located border.the center The of Chiang Hmong Rai Prov villagesince, while are located the Akha, along Yao and Thailand-Laos Lisu border. Allvillages study are siteslocated were along determined the Thailand on-Myanmar the 72 border. locations The andHmong elevated villages by are using located global along position system (GPS)Thailand (Garmin-Laos border. Oregon All 750,study Metro sites were Area, determined KS, USA). on the 72 locations and elevated by using global position system (GPS) (Garmin Oregon 750, Metro Area, KS, USA). FigureFigure 1. Study 1. Study sites sites of of six six hill hill tribestribes in in Chiang Chiang Rai Rai province, province, Thailand. Thailand. Int. J. Environ. Res. Public Health 2020, 17, 1698 3 of 13 2.2. Household Survey and Water Sampling This study was approved