According to a recent study conducted in the United Kingdom, high river pollution due to pharmaceuticals is a much greater danger to global health than previously assumed, The Guardian reported.

The study, published in the journal Proceedings of the National Academy of Sciences, is the largest ever conducted. With 127 researchers led by Dr. John Wilkinson of the University of York in the United Kingdom, pharmacological contamination in 1,000 water samples from 258 rivers in 104 countries was measured. 

They measured a total of 61 active pharmaceutical ingredients (APIs), mainly from hospital waste, waste products from water treatment facilities, septic tanks, and pharmaceutical manufacturing plants, as well as raw sewage discharge. 

According to World Bank data, almost 80% of wastewater is discharged into the environment untreated.

The most frequently detected in the study were carbamazepine (an anti-epileptic drug that is difficult to degrade), metformin (a diabetes drug), and caffeine. These were found in at least half of the rivers tested.

Rivers in Lahore, Pakistan; La Paz, Bolivia; and Addis Ababa, Ethiopia, contained the highest concentrations of APIs. In comparison, Glasgow (UK) and Dallas (USA) rivers were among the top 20% of rivers with the highest drug content, and Spain was in the top 10%.

With 34 different APIs, the Kai Tak River in Hong Kong obtained the record in the study.

Only two places were not contaminated: Iceland and a Venezuelan village where indigenous people do not use modern medicines, according to The Guardian.

Of the various pharmacological substances, antibiotics are of the most significant concern because they increase the risk of bacteria creating drug resistance.

According to the study published in The Lancet, the incidence of drug-resistant bacteria is highest in sub-Saharan Africa and South Asia. 

A river in Bangladesh had the highest antibiotic contamination, with levels of metronidazole 300 times higher than the permissible limit. The high level is in line with results from York, where both regions were shown to have the highest levels of pharmaceutical contamination, suggesting that river pollution may be playing a role in increasing resistance.

The Lancet study using statistical predictive models estimated that nearly 5 million people would have died from antibiotic-resistant bacterial infections.

“The World Health Organization and UN and other organisations say antimicrobial resistance is the single greatest threat to humanity,” Dr. Wilkinson, lead author of the study, told The Guardian.

He further added: “We know good sewage connectivity and wastewater treatment is the key to minimising, though not necessarily eliminating, pharmaceutical concentrations.” “However, that is extremely costly, as there is a lot of infrastructure involved.”

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