DRINKING WATER QUALITY AND ITS IMPACT ON PUBLIC HEALTH IN THE KHOREZM REGION, UZBEKISTAN: A NARRATIVE REVIEW OF EVIDENCE FROM 2008 TO 2025

Abstract

Safe drinking water is a fundamental human right, yet millions of people in Central Asia remain exposed to poor-quality water sources. The Khorezm region of Uzbekistan faces compounding environmental challenges, including the consequences of the Aral Sea ecological disaster, agricultural runoff containing persistent organic pollutants, climate-driven salinization, and deteriorating water infrastructure. This narrative review synthesizes evidence from peer-reviewed literature published between 2008 and 2025 to characterize the current state of drinking water quality in Khorezm and its associations with public health outcomes, particularly in children. The review identifies three principal water quality concerns: (1) fluoride deficiency (0.14–0.38 mg/L; WHO recommended range: 0.7–1.5 mg/L), associated with elevated dental caries prevalence; (2) excessive total dissolved solids (TDS) and water hardness, linked to urolithiasis and cardiovascular disease; and (3) microbial contamination in groundwater wells, directly associated with diarrhoeal disease burden in children under five (4.6 episodes/child/year). Organochlorine pesticide residues (DDT, γ-HCH) and heavy metals detected above international thresholds further compound health risks. We conclude with evidence-based recommendations for water fluoridation programmes, sanitary protection of groundwater sources, and seasonal microbiological surveillance.